This week in the BMJ
Volume 330, Number 7491, Issue of 12 Mar 2005Women at risk of pre-eclampsia can be identified in advance...
Women at risk of pre-eclampsia can be identified in advance...
Women who are at increased risk of developing pre-eclampsia can be identified at the time of antenatal booking. Reviewing 52 studies, Duckitt and Harrington (p 565) found that the most important risk factors for developing pre-eclampsia are a previous history and the presence of antiphospholipid antibodies. Pre-existing diabetes and a body mass index of 35 or more before pregnancy almost quadruple the risk; pre-existing hypertension, renal disease, chronic autoimmune disease, and 10 or more years between pregnancies increase the risk of developing pre-eclampsia to a lesser degree.
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... and early detection in the community is paramount
New guidelines may make early detection of pre-eclampsia in the community easier. Early identification of risk factors associated with pre-eclampsia should prompt referral to a specialist early during pregnancy, say Milne and colleagues (p 576). After 20 weeks of gestation, women should be assessed for the signs and symptoms of pre-eclampsia, and if they are found to be at risk of developing the disease they should be referred to a hospital day assessment unit with the facilities for step-up assessment.
Use PPIs in bleeding ulcer
Treating patients who have bleeding ulcers with proton pump inhibitors reduces complications. Reviewing 21 randomised controlled trials including 2915 patients, Leontiadis and colleagues (p 568) found that patients who were treated with a proton pump inhibitor were less likely to rebleed or need surgery after the initial gastric bleeding, than were those treated with an H2 receptor antagonist or placebo. Meta-analysis showed that treatment with proton pump inhibitors had no significant effect on mortality.
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Encouraging the use of folic acid is not enough
Advising women to take folic acid during pregnancy did not decrease the incidence of neural tube defects. Botto and colleagues (p 571) analysed 13 birth registries from Europe and Israel and found no changes in the trend of incidence of neural tube defects between 1988 and 1998, even though the use of folic acid supplements had been promoted. Public health agencies and medical professionals should consider implementing food fortification programmes, say the authors.
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Incidence of neural tube defects is stable in Europe
A survey across 16 European countries shows that the incidence of neural tube defects remained stable between 1980 and 1990. Busby and colleagues (p 574) found that the prevalence of neural tube defects still remains slightly higher in the United Kingdom and Ireland than the rest of Europe, even though it declined by 32% during the decade.
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Interpreting composite end points is challenging
The use of composite end points makes the interpretation of randomised trials challenging. The relative clinical importance of the end points varies, say Montori and colleagues (p 594), and their validity depends on similarity in importance to patients, treatment effect, and number of events across the components. When large variations exist between components, the composite end point should be abandoned, they say.
Electronic health records reduce office visits
Using an electronic health records system reduced visits to doctors' offices in Colorado and the northwest United States. Garrido and colleagues (p 581) found that two years after electronic health records had been fully implemented, age adjusted rates of office visits had fallen by 9%. Age adjusted primary care visits decreased by 11% in both of the regions, and specialty care visits decreased by 5% in Colorado and 6% in the northwest. The quality of care was not affected, say the authors, and there was no concomitant increase in use of other services.
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